The spine journal : official journal of the North American Spine Society
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Comparative Study
Is galvanic corrosion between titanium alloy and stainless steel spinal implants a clinical concern?
Surgeons are hesitant to mix components made of differing metal classes for fear of galvanic corrosion complications. However, in vitro studies have failed to show a significant potential for galvanic corrosion between titanium and stainless steel, the two primary metallic alloys used for spinal implants. Galvanic corrosion resulting from metal mixing has not been described in the literature for spinal implant systems. ⋯ The results from this study indicate that when loaded dynamically in saline, stainless steel implant components have a greater susceptibility to corrosion than titanium. Furthermore, the galvanic potential between the dissimilar metals does not cause a discernible effect on the corrosion of either. Although the mixture of titanium alloy with stainless steel is not advocated, the results of this study suggest that galvanic corrosion is less pronounced in SS-Ti mixed interfaces than in all stainless steel constructs.
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Comparative Study
Injury severity as primary predictor of outcome in acute spinal cord injury: retrospective results from a large multicenter clinical trial.
The prognostic value of injury severity and of anatomical region in acute spinal cord injury is strong, making it hard to evaluate other indicators or assess improvement without considering them. ⋯ AIS severity was the strongest predictor. Anatomical region was also strong but confounded with the severity effect, because the cervicals had fewer complete injuries, and because the cervical complete group did better than thoracic complete. The injury region/severity variable keeps the strong prognostic value of using both region and severity, but is simpler and more statistically economical.
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Despite the many published randomized clinical trials (RCTs), a substantial number of reviews and several national clinical guidelines, much controversy still remains regarding the evidence for or against efficacy of spinal manipulation for low back pain and neck pain. ⋯ Our data synthesis suggests that recommendations can be made with some confidence regarding the use of SMT and/or MOB as a viable option for the treatment of both low back pain and NP. There have been few high-quality trials distinguishing between acute and chronic patients, and most are limited to shorter-term follow-up. Future trials should examine well-defined subgroups of patients, further address the value of SMT and MOB for acute patients, establish optimal number of treatment visits and consider the cost-effectiveness of care.
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Randomized Controlled Trial Clinical Trial
Preemptive analgesia for postoperative pain relief in lumbosacral spine surgeries: a randomized controlled trial.
Administration of analgesic medication, before the actual onset of painful stimulus, is more effective than that after the onset of painful stimulus. This is the principle of preemptive analgesia. Although it is often considered superior to other forms of analgesia, its role in postoperative pain relief after lumbosacral spinal surgery has not been fully investigated. ⋯ Preemptive analgesia with a single caudal epidural injection of bupivacaine and tramadol is a safe, simple and effective method for postoperative pain relief.
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Surgery for adult spinal deformity may require both an anterior and posterior approach in order to stabilize the spine and achieve the desired correction. These procedures can be associated with significant pulmonary complications, including atelectasis, pneumonia and respiratory failure. The etiology of some of the respiratory complications is clear: poor inspiratory effort from incision pain and previous pulmonary disease. However, for many patients the direct cause of these complications is not obvious. ⋯ Radiographic abnormalities of the lungs are common after major spine surgery involving both an anterior and posterior approach, especially when the thoracic cavity is invaded. In view of the morbidity and longer hospital stay associated with such findings, close monitoring of pulmonary status with aggressive pulmonary toilet are indicated.